Relationship between various hepatic function scores and the formation of esophageal varices in patients with HIV/hepatitis C virus co‐infection due to contaminated blood products for hemophilia

Abstract

Aim It is reportedly difficult to accurately assess the liver reserve capacity of patients with HIV/hepatitis C virus (HCV) co‐infection through contaminated blood products by the Child–Pugh (CP) classification. Therefore, we investigated a clinically applicable scoring system in determining the risk of esophageal varices in HIV/HCV co‐infected patients, known as latent portal hypertension leading to esophageal varices. Methods Forty‐three patients with HIV/HCV co‐infection underwent clinical examinations, including endoscopy and assessment of hepatic reserve, in our department between 2009 and 2017. Child–Pugh score, the recently developed albumin–bilirubin (ALBI) grade, and the albumin–indocyanine green evaluation (ALICE) were compared to evaluate their diagnostic accuracy for the detection of esophageal varices using the area under the receiver operating characteristic curve (AUROC). Results The patients were all male hemophiliacs and were positive for both HIV and HCV antibodies, with a median age of 45 years (range, 29–66 years). Thirty‐seven patients (84.1%) were classified as CP A at the examination. The comparison of AUROCs showed a superior diagnostic accuracy for ALICE (AUROC = 0.814) to detect esophageal varices. The positive prediction rate was the highest with ALICE if −2.325 was set, and the negative prediction rate was the highest with ALBI if −2.575 was set. The ALICE showed the highest accuracy compared to other two scores. Conclusion The ALICE score was found to be the most valuable system for portal hypertension in HIV/HCV co‐infected hemophilia patients. Because of its high specificity, ALICE for secondary surveillance could be used after other markers such as the aspartate aminotransferase to platelet ratio index and Fibrosis‐4 index.

Presence of varices in patients after hepatitis C virus eradication predicts deterioration in the FIB‐4 index

“…Yoshimoto et al . also reported that the Albumin–Indocyanine Green Evaluation score, which includes factors that reflect portal hypertension, was useful to detect esophageal varices . In that study, Child–Pugh and albumin–bilirubin score did not correlate with varices, because they reflect liver synthetic dysfunction rather than portal hypertension.…”

Albumin–Indocyanine Green Evaluation (ALICE) grade combined with portal hypertension to predict post‐hepatectomy liver failure

“…In addition, previous studies reported that the ALICE score was more effective than the ALBI score in predicting the risks for PHLF for biliary tract cancer 22 or in detecting esophageal varices in HIV/hepatitis C virus co-infected hemophilia patients. 23 One of the limitations of our study is its retrospective design and single-institution patient cohort. The number of patients who developed PHLF was relatively small.…”

“…). In addition, previous studies reported that the ALICE score was more effective than the ALBI score in predicting the risks for PHLF for biliary tract cancer or in detecting esophageal varices in HIV/hepatitis C virus co‐infected hemophilia patients …”

Comparison of new prognostic systems for patients with resectable hepatocellular carcinoma: Albumin‐Bilirubin grade and Albumin‐Indocyanine Green Evaluation grade

“…The ALICE score is calculated, including the indocyanine green retention rate at 15 min (ICG R15) and albumin, using the following formula: 0.663 × log 10 ICG R15 (%) – 0.0718 × albumin (g/L), and also divided into three grades by the ALICE grade (cut‐off values of grades 1/2 and 2/3 were −2.20 and −1.39, respectively). To the best of our knowledge, the usefulness of the ALICE grade system has not been substantially considered, and only a few articles have compared these two grading systems …”

“…To the best of our knowledge, the usefulness of the ALICE grade system has not been substantially considered, and only a few articles have compared these two grading systems. [10][11][12] In the present study, we investigated the utility of the ALBI and ALICE grades as a validation cohort, and compared the prognostic impact of these systems on patients with resectable HCC using a multi-institutional database.…”